Wolfgang TRUBEL M.D.

Professor of Surgery, Chief consultant

I am pleased to welcome you on the website of my private practice! The following information is dedicated to all persons, who are suffering from chronic venous insufficiency and/ or varices and need qualified information and medical help.

At the following pages you can inform yourself about the aetiological factors of varicosity and the diagnostic procedures by clinical examination and ultrasound. Detailed information is given to you concerning the MIC - procedure, a combined and very effective method for a permanent treatment of varicosity and venous insufficiency.

Within an individual consultation in my practice I examine the functional status and potential disorders of your venous system in detail and explain all treatment options to you in English.

Appointment

by phone +43 664 12 45 1 45 - daily during 2-5 p.m.
or e-Mail dr.trubel@vienna.at.

Address

Hainburger Strasse 21, 1030 Vienna, Austria

NEW TREATMENT FOR VARICOSE VEINS

New procedure

Minimally invasive combined (MIC-) varicose vein therapy - a new combined procedure to treat varicose veins

In vein stripping, which for many decades was considered the only surgical procedure to treat varicose veins, the so-called great saphenous vein, which the varicose veins mostly originate from, is threaded in two steps by means of small wire and pulled out. The lateral branches of the main varicose vein are removed via several small incisions. For this relatively costly surgical intervention, patients have to stay in hospital for some days and expect to be on sick leave for 1-2 weeks. The operation requires several incisions in the skin, results in painful bruising and scars and may lead to unpleasant, long-lasting side effects such as nerve irritation.

If the varicose veins are treated from the inside only (= endovascular procedures such as sclerotherapy, the new sclerosing microfoam therapy and also novel endo-laser techniques), very good medical and cosmetic results are achieved on an outpatient basis and without disturbing scars in the short run. However, these procedures have the disadvantage that they cannot remove the origin of the varicose veins, which means that the varicose veins are bound to reoccur.

A new combined treatment procedure to remove varicose veins, which was first developed in in the Netherlands and has been used there successfully for many years, is now also being offered in Austria. This minimally invasive combined (MIC) varicose vein therapy combines the advantages of surgery and of endovascular treatment. It can be done on an outpatient basis and does not require hospitalization and general anesthesia. Surgery is done with local anesthesia primarily at the point the varicose veins originate from (in the groin or behind the knee). The remaining varicose veins are removed immediately afterwards by special sclerotherapy and in individual cases by means of laser. This combined treatment is popular with many patients as it is easy on the body and results in few complications, but also because during treatment patients can lead a largely normal life. And above all: the long-term results are excellent!

The combined MIC varicose vein therapy is already offered at several vein centers in Austria, and I operate on almost all my patients according to this combined method as I have made excellent experience with this procedure. I collaborate closely with the sclerotherapy expert Dr. Kögler, a very experienced vein specialist, who does the follow-up treatment of my patients treated in this combined manner.

Check-ups carried out (free of charge) in a multi-center study involving many patients have confirmed that this new combined method to treat varicose veins achieved a sustained success rate in a high percentage of patients over many years, with a rate of complications that was negligible due to the gentleness of the procedure.

You can now get detailed information on the basis, prerequisites and the step-by-step procedure of the MIC varicose vein treatment. An assessment of your veins and an ultrasound examination can help determine whether this novel procedure can be performed on you as well.

How does the blood get back from the legs to the heart?

The blood is transported back to the heart through the veins. In the legs this is done above all by the deep leg vein, which is surrounded by muscles, cannot be seen or palpated anywhere, has the diameter of about a finger and transports more than 95% of the blood straight to the heart.

Directly under the skin there are two vein stems usually about as thick as a straw, which are called the great and small saphenous veins. It is from these two superficial veins that the varicose veins usually originate. In healthy persons the saphenous veins carry about 5% of the blood upwards and drain into the deep vein at the groin (great saphenous vein) or behind the knee (small saphenous vein). The deep vein then carries also this blood farther up into the heart. The saphenous veins are connected with the deep leg vein also via many smaller connecting veins, but these interconnecting veins called perforating veins play a minor role in healthy persons.

Blood is a heavy liquid and does not flow by itself against gravity from the leg up to the heart. The movement of the leg muscles squeezes the veins, and the venous valves – small double doors that open only upwards – prevent the blood from flowing back into the leg. The saphenous veins have at their draining points the most important venous valves (draining valves) that make sure that the blood will only flow up into the deep leg vein and on to the heart.

What causes varicose veins in the legs in most patients?

If a venous valve at the mouth into the deep leg vein is not tight and leaks, the blood flows into the wrong direction following gravity. Thus the blood flows from the deep vein back into the superficial veins in the leg instead of going up to the heart against the effect of gravity. This phenomenon, which is called reflux, results in overloading the superficial veins so that they expand and turn into varicose veins. The more these veins widen, the more blood flows back into the leg, and the varicose veins gradually worsen. In addition, the reflux in the leg also leads to swelling and skin damage.

Important! The point of origin of varicose veins is always higher than the varicose veins themselves. Only if the cause of venous disease – the reflux – is removed, permanent success of therapy is possible!

If the ultrasound examination shows that a reflux in the groin or behind the knee is the cause of venous disease, this reflux must be eliminated in order to keep the blood in the deep leg vein. Only if this is done, can varicose veins be treated in a sustained manner.

How is the small operation to remove the cause of varicose veins performed?

The small operation that eliminates the reflux and thus the cause of venous disease is called crossectomy. It can be performed mostly without causing pain using a local anesthetic. Depending on whether the great or small saphenous veins are affected, surgery is done via a small incision in the groin or behind the knee with patients lying on their back or belly. The deep leg vein is identified and permanently sewn up at the place of the insufficient venous valve. Then the muscle tissue is closed over it, so that the deep leg vein in this area does not have any connections to the surface any more. The upper part of the saphenous vein is removed, and the lower part is sewn up as well. All the lateral branches in the area are dealt with in this way as they, too, can be points of origin of varicose veins. The small incisions are closed water-tight using cosmetic suture techniques. The procedure takes about 30 minutes. You can then get up and walk without any problems.

After surgery, you can get back to your daily routines without any major restrictions, and painkillers are required in rare cases only. You do not have to take any special precautions after the operation, but you had better avoid strenuous physical exercise for a few days. Wound healing takes about 5-6 days, and then the band-aid and the sutures are removed.

When and how are the remaining varicose veins removed?

Right after crossectomy, sclerotherapy is done, which takes about 20 minutes. First, the leaky connecting veins are identified by means of ultrasound on the dangling leg. They are sealed off during sclerotherapy by means of a special technique, and the superficial varicose veins are filled with a foamed sclerosing agent (= microfoam sclerotherapy) if necessary. Then an elastic bandage and, on top of it, a light compression stocking are put on. Both stay on for a maximum of 5 days. Due to this sclerosing action, the varicose veins soon stick together so tightly that the body degrades them. The body itself thus "operates" on the varicose veins, and no further incisions are required on the leg. By the end of the treatment only the functional and healthy parts of the superficial veins remain.

What happens when the point of origin of varicose veins is treated insufficiently?

The consequences of inadequate vein treatment are unfortunately still often seen these days as vein stripping in previous years frequently sealed off deep leg veins only insufficiently, and the origin of venous disease was thus not eliminated: the deep leg vein, sealed off incompletely, continues to leak blood, which results in the venous stump sprouting new varicose veins. These new varicose veins usually form near the groin or behind the knee and thus point to the origin of the disease - the point of origin of varicose veins that was treated insufficiently.

You can imagine this in much the same way as when the branches of a tree are cut off, and the stumps of the branches are left on the tree – these stumps also sprout new small branches. If, however, the cut is made right on the tree trunk, and the spot is sealed off, no new unwanted branches start growing.

A permanent sealing of the deep leg vein and thus a complete elimination of the origin of venous disease can only be done by completely sewing up the area where the varicose veins originate. For this, vascular sutures that do not disintegrate and are well tolerated need to be used. It goes without saying that the deep leg vein must not be damaged or constricted in any way.

If the permanent healing of venous disease, and not just temporary improvement, is the aim, the quality of vein therapy must be measured by meeting this basic prerequisite – the permanent elimination of the point of origin of varicose veins! A permanent closure of varicose veins comparable to surgical suturing cannot be achieved with any endovascular procedure, neither with the endo-laser, nor by means of microfoam sclerotherapy alone. In order to bring about satisfactory and permanent therapy results, the reflux must be eliminated by means of surgery.